在冠状动脉再血管化后,医生计费和心脏应力测试模式之间的关联
Bimal R Shah1, Patricia A Cowper, Sean M O'Brien
1Duke Clinical Research Institute and Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA. bimal.shah@duke.edu
JAMA
|November 10, 2011
概括
医生计费实践显著影响了冠状动脉再血管化后的心脏应力测试的利用. 为技术或专业费用收费的医生订购了更多的核压力测试和压力心声图.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 医学经济学 医学经济学
背景情况:
- 经济激励可能会影响心脏应激成像的使用.
- 医生计费和压力测试之间的关系尚未得到充分理解.
研究的目的:
- 调查医生计费实践与核压力测试和压力心声学利用之间的关联.
- 分析技术和/或专业费用的计费如何影响重血管化后压力测试.
主要方法:
- 对17847名接受冠状动脉再血管化的患者进行了回顾性分析.
- 医生按技术费用,专业费用或两者都没有的计费方式分类.
- 对患者和医生因素进行调整的后勤回归模型.
主要成果:
- 与那些医生不收费的患者相比,医生收费技术/专业费用的治疗患者的核应力测试 (OR 2.3 和 1.6) 和应力心声图 (OR 12.8 和 7.1) 率较高.
- 整体压力测试发生率为12.2%在门诊访问后的30天内.
结论:
- 医生对技术和/或专业费用的计费与冠状动脉再血管化后核和心声压力测试的使用增加有关.
- 财务因素似乎在心脏应激成像程序的订单中发挥了作用.
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